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          <h1 class="post-title" itemprop="name headline">024.2019新锐读会 课程笔记《粘接牙科学的基本原理》07</h1>
        

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        <p>b.化学界面的形成<br>1.硅烷偶联剂的应用必要性<br>HF处理后的界面无法和粘接剂及树脂水门汀中的有机树脂基质结合。<br>HF处理后的界面需要沉积有机功能基团。<br>硅烷偶联剂可以与HF处理过的陶瓷结合并提供有机功能基团。<br>2.常用硅烷偶联剂的组成成分分析<br>牙科广泛使用的硅烷偶联剂为3巯丙基三甲氧基硅烷  3-MPTMS<br>结构式为Y-CH2-CH2-CH2-Si-X<br>也叫陶瓷底涂剂或陶瓷涂底剂。<br>3.硅烷偶联剂的应用原理<br>硅烷中的低活性烷氧基（-Si-OR）先水解为活性的硅醇基（Si-OH）<br>R-Si-(OR’)3+H+H2O – R-Si-(OH)3+3R’OH<br>陶瓷表面涂布硅烷偶联剂后，两个羟基功能基团发生缩合反应形成稳定硅氧烷共价键。<br>R-Si-OH + HO-Si-(瓷) – R-Si-O-Si-(瓷) + H2O<br>4.硅烷偶联剂涂布后的热动力原理(Le Chatelier原理）<br>R-Si-OH + HO-Si-(瓷) – R-Si-O-Si-(瓷) + H2O (用热吹风 1600W， 30-60s；或热，烤箱100度2min去除）<br>R-Si-OH + HO-Si-(瓷) – R-Si-O-Si-(瓷) + H2O (水量减少，打破化学平衡加快生成从而加速硅烷化速度）<br>用热吹风或者反应5分钟冷吹风均可。<br>5.硅烷化的陶瓷热吹风吹干不同时间的接触角<br>吹60s接触角最大，时间更长则接触角会降低。<br>6.硅烷化完成对瓷界面性质的改变。<br>从HF处理后的亲水性变为疏水性，易与树脂结合。<br>7.硅烷偶联剂在瓷表面与树脂基质间的偶联模式<br>陶瓷底层-硅烷偶联剂-树脂基质<br>8.硅烷偶联剂涂布的厚度与遍数<br>没有必要涂太多层，只有第一层完全发生了化学反应（表面分子化学反应）。陶瓷表面只与第一层硅烷发生反应，其它硅烷层不会与陶瓷表面结合。过量硅烷通过氢键互相缠绕会降低与树脂的结合。<br>9.硅烷偶联剂的分类与选择及“失活”<br>A.硅烷偶联剂的分类<br>①按瓶的数量来分：<br>单瓶预水解硅烷（水解型硅烷）：使用方便。缺点，有效期短，24个月。高温、阳光下均易发生反应。<br>Porcelain-Bisco<br>RelyX Ceramic-3M ESPE<br>Clearfil Ceramic<br>MonobondPlus_IvoclarVivadent<br>Kerr<br>双瓶（非水解硅烷+酸性水溶液）：保存条件不苛刻，现用现混。<br>BIS-SILANE, BISCO<br>使用较多，量大，保存规范。用单瓶。<br>否则，用双瓶。<br>②按成分来分：<br>硅烷单体作为活性成分的普通硅烷。(只能处理玻璃基陶瓷）<br>Porcelain-Bisco<br>RelyX Ceramic-3M ESPE<br>Monobond S-IvoclarVivadent<br>含磷酸单体的硅烷/磷酸盐成分的硅烷。(可以处理玻璃基陶瓷和氧化锆，但效果并不好。）<br>Clearfil Ceramic<br>MonobondPlus-IvoclarVivadent<br>含酸性树脂底漆成分的硅烷。(反应产生水，影响树脂底漆成分）<br>ScotchBond Universal(3M)<br>Opti Bond Versal(Kerr)<br>临床最好使用单纯型的硅烷。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0171-rdh-gw/01.png"><br>B.硅烷偶联剂的选择<br>按成分来选择，尽量选择含纯硅烷单体的，不建议选择硅烷中含树脂/磷酸盐类的。<br>C.硅烷偶联剂的“失活”<br>单瓶预水解硅烷易降解老化形成多聚体而导致失活（白色絮状物）。双瓶相对更容易保存。<br>10.酸处理及硅烷涂布的时机<br>涂布硅烷以前，是高能亲水表面，易污染。<br>涂布硅烷之后，是低能疏水表面，不易被污染。<br>不建议技师提前用氢氟酸处理。<br>眼见为实，能自己动手的，别请别人代劳。<br>HF酸处理及硅烷偶联剂的时机选择——酸处理的时机。<br>a.模型受到HF处理后硅烷偶联剂涂布后预约患者<br>①足够的时间释放缩合反应产生的水<br>②防止试戴时血液及唾液的污染（疏水表面）<br>③试戴后超声有利于清除污染及多余硅烷偶联剂（单层）<br>b.已约患者，椅旁HF处理后涂布<br>①无足够的时间释放缩合反应产生的水只能靠单一热处理方法<br>②虽已热吹风处理但接触角仍小于a模式<br>③粘接强度略小于a模式。<br>如果是一次粘大量的修复体，且技师较好，可以提前处理，释放临床时间。<br>少量修复体，技师较陌生，可能要调磨组织面。不建议提前处理。<br>第四节 粘接系统与复合材料<br>a.常用水门汀分类<br>光固化水门汀（贴面一定用这个，双固化含有胺，会降解，颜色会变化）、自粘接水门汀、双固化树脂水门汀（嵌体用这个）<br>b.玻璃基陶瓷粘接水门汀的选择<br>上面已说了。<br>c.玻璃基陶瓷粘接流程<br>1.嵌体的粘接流程<br>第一步：取掉口内临时修复体，清洁预备体<br>第二步：试戴玻璃基陶瓷嵌体（调颌在模型上或粘接完成再调）<br>第三步：清洁玻璃基陶瓷嵌体（如未被唾液污染，可以酒精擦拭后用HF处理。如果被唾液污染，用义获嘉的碱性制剂去处理组织面。）<br>第四步：9.5%HF酸蚀组织面锂基E.Max 20s，白榴石基 60s。<br>第五步：酸蚀满足时间后冲洗1分钟。<br>第六步：超声荡洗2-5min<br>第七步：涂布硅烷偶联剂一层5min干燥<br>第八步：嵌体厚度在2mm左右时可涂布瓷粘接剂吹薄不固化<br>第九步：嵌体厚度&gt;3mm可不涂任何粘接剂（临床上基本不涂）<br>第十步：IDS区域或重建区域上障喷砂：成分，氧化铝；直径&lt;50μm；喷砂压力:2-3bar；时间10s；距离1-2cm<br>第十一步：釉质龋35%磷酸酸蚀30s（喷砂后IDS界面可以酸蚀15s清洁）<br>强吸吸净水雾冲洗15s。<br>彻底干燥。<br>涂布All-Bond-3 A+B<br>涂抹20s后温柔而彻底干燥10s表面发亮。轴壁和髓壁处无粘接剂淤积。<br>光固化10s。<br>第十二步：预备体及嵌体组织面（厚度&gt;3mm）涂布双固化水门汀<br>厚度2mm左右时可选用光固化树脂水门汀或加热的充填树脂，就位嵌体。</p>
<p>个人总结：硅烷偶联剂的原理，是分别与修复体瓷表面和树脂粘结剂都形成化学连接。反应的副产物是水，因此可以用热吹风或者反应5分钟冷吹风来去除。吹60s时接触角最大。HF处理后的修复体表面为亲水性，硅烷处理后变成疏水性。硅烷偶联剂与修复体反应只在表层进行，因此涂一遍即可。硅烷偶联剂分成单瓶装和双瓶装。前者使用方便，但保存要求高，有效期短。后者反之。建议用量大可选前者，用量小选后者。按成分又可以分成单组分以及加了MDP或树脂底漆成分的混合组分，建议选择单组分的。单瓶硅烷偶联剂易互相聚合形成多聚物，形成絮状物，即失活。涂硅烷以前，界面为亲水的，易被污染，硅烷处理后变成疏水界面，不易被污染。因此不要请技师氢氟酸处理修复体表面。粘接模式有两种，一种是约患者以前就用HF+硅烷处理，另一种是在椅旁处理。根据情况选择。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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